As 2017 open enrollment gets underway and the 2016 general election nears, Arizona remains a state divided on Obamacare as well as whom the next U.S. president should be. The Arizona Republic reported October 21 that 39 percent of Arizona surveyed supported Hillary Clinton and 33.9 percent and 33.9 percent were for Donald Trump; 53 percent said they were opposed or strongly opposed to the ACA and 40 percent responded that they supported or strongly supported it.
In the case of both events, the nation’s eyes are on The Grand Canyon State. Arizona is a swing state in which 53.7 percent of voters supported Republican Mitt Romney in the 2012 presidential election. It is also at the center of conversations about healthcare and immigration, with a substantial Hispanic population and health insurance rates skyrocketing in 2017.
The average cost of mid-level plans purchased through the state’s federally facilitated health insurance exchange will increase an average of 116 percent. However, nearly 7 in 10 Arizonans who buy exchange plans get subsidies that lower what they pay in monthly premium. Options will also decline sharply. In 2015, there were 11 carriers offering exchange plans in Arizona. In 2017, there are two: Blue Cross Blue Shield, for which regulators approved an average rate increase of 51 percent rate, and Centene/Ambetter from Health Net, for which an average rate increase of 74.5 percent was approved. Only one county will have more than a single option when it comes to health insurance companies; Pima County will include both Centene/Ambetter from Health Net plans and a “catastrophic” plan from Blue Cross Blue Shield.
Arizona’s population grew by 25 percent between 2000 and 2010, and the influx continues. The outcomes of the 2016 election and 2017 open enrollment are sure to have an impact. We’ve put together a summary of Arizona’s overall public health rankings, ACA history, health insurance options, and Medicare and Medicaid enrollment in recent years.
How Arizona compares in state health rankings
Arizona is rated 33th by the Scorecard on State Health System Performance 2015, which compares the 50 states and the District of Columbia. Though in the 4th quintile two categories: Access and Prevention & Treatment, the state ranked in the first quintile (10th) for Avoidable Hospital Use & Costs.
Despite enrollment improvements, Arizona’s uninsured rates continue to be relatively high. To rise to the level of the best-performing state, about 515,316 more Arizona adults would need to become insured. Arizona ranked 36th for its percentage of uninsured adults ages 19 to 64 and 45 for its percentage of uninsured children ages 0 to 18. Check out Arizona’s Scorecard for more details.
Arizona fared about the same for the 2015 edition of America’s Health Rankings, coming in at #30. The state earned 41st, 42nd and 43rd for lack of health insurance, access to primary care physicians, and childhood immunization.
Visit Key Health Data About Arizona to see how Arizona ranks on additional health indicators, public health readiness measures, and public health funding indicators.
Health status can vary significantly across a state. For a more focused look, review county-by-county ratings for Arizona; this data comes from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
How has Obamacare helped Arizona’s uninsured?
Arizona participates in the federally facilitated marketplace (HealthCare.gov) and has expanded its Medicaid program under the ACA. It is among four states that have expanded Medicaid without administering a state-based exchange or partnership; North Dakota, Ohio and New Jersey are the other three.
Depending on the study, Arizona saw a somewhere between a 2.9 percent and 3.74 percent drop in its uninsured rate over the course of the 2014 open enrollment period, falling to somewhere between 16.38 and 17.5 percent.
By late 2015, Gallup showed Arizona’s uninsured rate to be 13.7 percent – down 6.7 percent from 2013, before Obamacare’s individual mandate took effect.
While Arizona’s uninsured rate continues to improve with Obamacare in effect, it remained above the national average (11.7 percent) in 2015 and is still considered high.
2017 rates and carriers for AZ
When the first ACA open enrollment began, Arizona’s health insurance exchange was rife with carrier options. The number dropped to 11 in 2015, and then eight in 2016 — Meritus, the state’s Consumer Operated and Oriented Plan was among 12 CO-OPs that had folded by early November 2015.
With the Aetna’s departure from the Arizona exchange and Cigna’s decision to exit Maricopa County (the only county where they were planning to offer coverage) at the end of 2016, the following carriers will offer 2017 coverage to Arizonans through the exchange:
- Blue Cross Blue Shield – approved average rate increase of 51 percent
- Centene/Ambetter from Health Net – approved average rate increase of 74.5 percent
Of course, not every carrier will offer plans in every county. All but Pima County will have a single option. As of August 2016, Pinal County, Ariz., was without a carrier for 2017 open enrollment, leading Kaiser Health News to call it “an Obamacare ghost town”; however, BCBS of Arizona announced in September that it had reversed its decision and would continue to sell exchange plans there.
Arizonans enrolled in qualified health plans
Research by the Kaiser Family Foundation estimated Arizona’s potential market for the health insurance exchange at 551,000 and estimated that 313,000 of those potential consumers would qualify for tax subsidies. Actual results from the 2014 open enrollment period showed that 120,071 people signed up for qualified health plans (QHPs) through Arizona’s health insurance exchange and 144,376 qualified for financial assistance.
During 2016 open enrollment, 203,066 people enrolled in private health plans through Arizona’s exchange. While the initial enrollment was slightly less than it was in 2015, effectuated enrollment as of March 31, 2016, was 8 percent higher than a year prior.
AZ and the Affordable Care Act
In voting on the Affordable Care Act, Sens. John McCain and Jon Kyl voted no. Arizona’s eight representatives split their votes along party lines: the four Democrats voted yes, while the four Republicans voted no. The ACA was signed into law in March 2010.
Former Arizona Gov. Jan Brewer, a Republican, was vocally opposed to the Affordable Care Act, even calling a special legislative session in 2010 to advance her position. Brewer wanted permission to join the lawsuit challenging the healthcare reform law after the state’s Democratic attorney general refused to join the suit.
In the 2010 election, Arizona voters approved a state constitutional amendment barring any rules or regulations that would force state residents to participate in a healthcare system.
Despite opposing the overall ACA, Brewer was in favor of state-run health insurance exchange and said it was preferable to a one-size-fits-all model imposed by the federal government. To that end, Brewer established the Office of Health Insurance Exchange, and the state took numerous steps toward setting up a state-run exchange. However, state legislators and a public majority remaining opposed. Brewer ultimately bowed to public sentiment and defaulted to the federally facilitated marketplace. The state did opt to expand Medicaid under the Affordable Care Act.
Doug Ducey, a Republican, took over the governor’s office in January 2015. During his campaign, he described himself as “100 percent opposed to Obamacare.” Within months of taking office, he signed House Bill 2643 into law, effectively banning the state from creating a state-run exchange.
Medicaid in Arizona
Former Gov. Brewer followed a different course than most Republican governors and pushed hard for Medicaid expansion in Arizona. A bill authorizing expansion was passed with some Republican support and signed into law by Brewer in 2013.
However, the expansion has been repeatedly challenged. Most recently, Gov. Ducey wants CMS to approve a waiver that would add eligibility restrictions to Arizona’s Medicaid program – Arizona Health Care Cost Containment System (AHCCCS, which is pronounced “access”).
With Arizona Medicaid expansion in place for now, 58 percent of uninsured nonelderly people in Arizona are eligible for financial assistance to gain medical insurance coverage through either Medicaid or the marketplace. Forty-two percent of those currently uninsured are not eligible due to immigration status.
Arizona has seen a 40 percent increase in monthly Medicaid enrollment from 2013 to June 2016, the 14th largest change nationwide. Nationally, the average increase is 27 percent.
Learn more about Arizona’s Medicaid program at the Arizona Health Care Cost Containment System website.
Medicare enrollment in the state of Arizona
In 2014, Medicare spent about $8,063 per Arizona enrollee, slightly lower than the national average of $8,970. In 2009, the most recent year for which data is available, Arizona ranked 18th overall in Medicare spending with $8.5 billion annually.
Arizona Medicare recipients who want additional benefits beyond what original Medicare offers can select a Medicare Advantage plan instead, and 38 percent made this choice in 2015. Thirty-one percent of Medicare beneficiaries nationwide were enrolled in Medicare Advantage plans that year.
Arizona health reform legislation
Here’s what’s happening legislatively with healthcare reform at the state level in Arizona:
- The Arizona legislature in February 2015 passed SB1092, which requires the state to seek an annual waiver from CMS to allow additional Medicaid eligibility restrictions. Gov. Ducey signed the bill into law in March. As of October 2015, CMS was reviewing the 2015 waiver proposal.
- Gov. Ducey signed HB2643 into law in April 2015. The legislation effectively bans the state from creating a state-run exchange.
Here’s a round-up of other healthcare reform legislation at the state level in Arizona: